Hologram Doctor: Not Who I'd Like to Visit, Says Ethicist

Medscape

5 days ago

This transcript has been edited for clarity.
Hi. I'm Art Caplan. I'm at the Division of Medical Ethics, at NYU Langone Health System in New York City.
I am not a hologram. What am I talking about? Well, a new cancer clinic in Tennessee is starting to offer to its patients a hologram doctor.
Some of you will know what this is like. It's been used now in shows and performances, like at Sphere in Las Vegas. All of a sudden, you're able to go to a show by Michael Jackson, who is long since dead, but they can project him onto the stage. This is also true for other singers, performers, or even figures from the past. They're very realistic looking, and you feel like you're in the presence of maybe someone who's still alive.
That technology is being touted as a way to improve care for people in rural areas. Many of those folks have to travel very far to get regular exams and surveillance from a doctor or a nurse. Some of them require a 3- or 4-hour drive. It's a real burden. It's hard for many of these people, some of whom are frail, older, or sick from the treatments themselves. It's hard for them to get there.
The clinic has come up with this idea to make a hologram of a generic doctor, put that doctor in a studio with good lighting and good technology, and beam it out to the homes of these patients — or let them travel somewhere where the setup is a little more friendly that is maybe not 3 hours away. Maybe they could have studios that, for many people, are only an hour away.
I see some benefit. I think doing video conferencing and that style of thing often is a little cold and distant. The lighting isn't good, and the sound may be bad. It's not a professional production, and it may not give you the nuance and the detail that you want to see if you're trying to do an exam. It's better, if you will, to have the higher-level tech.
There are issues. One, in rural areas, we don't really have great Wi-Fi service. The rates of carrying detailed signals aren't that good. I'm not sure much of this is going to make it into a rural person's home. I still see travel required, which cuts back in some ways on the attractiveness. It may be better to send the actual doctor to four or five clinics once in a while than to try and rely on the hologram doctor going out to the rural patients at locations where the signal still is not going to be that great.
I also worry that for much of this work, while you can see some things, you can't see other things. Yes, you can detect a rash, and sure, you could see certain things about certain skin cancers, but are we really ready to say that we can conduct an exam remotely on a cancer patient with complicated disease? I'm not sure.
Again, I'm no oncologist, but it makes me nervous that a thorough exam would be something you could do. In a weird way, this might work better for dermatology. It might work better for certain kinds of family medicine practice, where someone's nervous about a rash, headache, or some symptoms that you could handle remotely. This patient group strikes me as maybe more complicated.
The other problem is the legal situation is unclear. What would it mean to make an error? What would it mean to actually give bad advice or misdiagnose? Who's responsible? Who's going to be able to hold someone accountable? What if the patient really isn't comfortable and doesn't give you all the information that they might if it was face-to-face?
In person, that whole area looks murky, unresolved, and even dangerous to practice in until the rules are laid out clearly about who's responsible for what and what the standard of care is for using this kind of technology.
Are we going to see more of it in the future? I think so. Is it ready for prime time now to an underserved rural population? I'm not sure it's here yet.
We'll have to keep an eye on it. Maybe improvements will come. Maybe our infrastructure for handling Wi-Fi and this kind of thing will improve, but for now, I'm not sure that the hologram doctor is the doctor that I'd want to visit.
I'm Art Caplan, at the Division of Medical Ethics at NYU Langone Health Systems. Thanks for watching.